Review the CMS Final Rule 2023 for IPPS: Payment Increases & NTAP Updates

Review the CMS Final Rule 2023 for IPPS: Payment Increases & NTAP Updates

Final details for FY 2023 changes were made available with the release of the CMS Final Rule 2023 for IPPS on August 1, 2022. Enroll in the 2023 IPPS and MS-DRG update presentation from YES HIM Education.

The rule includes information on overall reimbursement adjustments and updates to MS-DRGs, New Technology Add-on Payments (NTAP), the Medicare Code Editor (MCE), and many other changes. Also included in the rule are tables with the finalized lists of new, revised, and deleted ICD-10-CM and ICD-10-PCS codes.

CMS Fact Sheet Outlines Changes and Payment Updates

CMS released a fact sheet with a synopsis of many of the changes. General acute care hospitals that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and meaningful EHR users will see a payment increase of 4.3%. The increase is 1.1% more than the update listed in the Proposed Rule.

These changes will result in an increase of approximately $2.6 billion in hospital payments for FY 2023. CMS is returning to its use of the most recent available data to determine payment rates, with modifications due to the COVID-19 public health emergency (PHE).

New Technology Add-On Payments

cms final rule 2023

In total, 25 technologies are eligible for add-on payments for FY 2023, with an estimated cost of $784 million. This includes approval of eight new applications: three traditional and five alternative pathway applications for new medical devices.

Conditional approval for an infectious disease product that awaits FDA approval was also processed, and another technology was determined to be similar to an existing 2022 NTAP. In addition, 15 new technologies will continue to receive payment for the year, bringing the total to 25.

MS-DRG Changes

Notably, there are no new MS-DRGs for 2023, with the final number staying at 767. Laser Interstitial Thermal Therapy (LITT) procedures have been reclassified, along with new procedure codes in the Medical and Surgical section of ICD-10-PCS.

Implementation of the “three-way split criteria” for MS-DRGs has been further delayed due to the impact of the COVID-19 PHE. Several technical refinements of existing MS-DRGs are included in the final rule.

Social Determinants of Health Diagnosis Codes

CMS requested comments on how these codes could improve the ability to recognize severity of illness, complexity of service, and/or utilization of resources in the MS-DRGs system, including supporting efforts to advance health equity. Many comments were received and will be considered in future rulemaking, particularly the possibility of including homelessness as a complication or comorbidity (CC) vs. a NonCC element.

Equity and Maternal Health Quality Measures

The CMS Final Rule 2023 also includes three health-equity measures in hospital quality programs. Also, it establishes a “Birthing-Friendly” hospital designation for facilities that participate in state or national perinatal improvement programs. A separate fact sheet specific to these measures is available.

More Details in the Final Rule

The CMS Final Rule 2023 is over 2,000 pages long. It includes a synopsis of comments received on all provisions from the Proposed Rule and a description of the final decisions. It features details on initiatives such as hospital inpatient quality reporting (IQR), Hospital Readmissions Reduction Program (HRRP), the Hospital-Acquired Condition (HAC) Reduction Program, and the Hospital Value-Based Purchasing Program (VBP). See the Final Rule for more information on these and other programs.

YES Update Presentations

CMS final rule 2023 IPPS update

YES HIM Consulting has detailed information on all the changes coming for October 1, 2022 in several on-demand webinars. A review of the more than 1,100 code changes for ICD-10-CM is available in this course, with a separate presentation on updated official coding guidelines. The presentation explores ICD-10-PCS changes with New Technology changes in a separate presentation. An overview of the IPPS and MS-DRG changes is also available. Stay tuned to the YES Blog for those presentations.

Additional Updates

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Teri Jorwic

Contract Educator, MPH, RHIA, CCS, CCS-P, FAHIMA
cms final rule 2023

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